Bone fusion device

ABSTRACT

A bone fusion device for insertion between bones that are to be fused together, such as, for example, the vertebrae of a spinal column. The bone fusion device comprises at least one extendable tab and one or more tab extension assemblies. Each tab extension assembly is able to be adjusted in order to individually control the extension or contraction of a side of the tab thereby enabling adjustment of the height and/or angle of the tab with respect to the body of the bone fusion device. Each tab extension assembly is able to be individually adjusted such that the side controlled by each assembly is raised or lowered until the desired tab angle is achieved. The tab is advantageously positioned and angled to correspond to the vertebrae to help brace the device until the bone has fused.

RELATED APPLICATIONS

This application claims priority under 35 U.S.C. § 119(e) of U.S.Provisional Patent Application Ser. No. 61/624,155, filed Apr. 13, 2012,and entitled “BONE FUSION DEVICE,” which is hereby incorporated byreference.

FIELD OF THE INVENTION

This invention relates generally to bone fusion devices. Morespecifically, the present invention relates to devices for fusingvertebrae of the spine that can be inserted arthroscopically.

BACKGROUND OF THE INVENTION

The spinal column is made up of vertebrae stacked on top of one another.Between the vertebrae are discs which are gel-like cushions that act asshock-absorbers and keep the spine flexible. Injury, disease, orexcessive pressure on the discs can cause degenerative disc disease orother disorders where the disc becomes thinner and allows the vertebraeto move closer together or become misaligned. As a result, nerves maybecome pinched, causing pain that radiates into other parts of the body,or instability of the vertebrae may ensue.

One method for correcting disc-related disorders is to insert a fusioncage between the vertebrae to act as a structural replacement for thedeteriorated disc. The fusion cage is typically a hollow metal deviceusually made of titanium. Once inserted, the fusion cage maintains theproper separation between the vertebrae to prevent nerves from beingpinched and provides structural stability to the spine. Also, the insideof the cage is filled with bone graft material which eventually fusespermanently with the adjacent vertebrae into a single unit.

The use of fusion cages for fusion and stabilization of vertebrae in thespine is known in the prior art. U.S. Pat. No. 4,961,740 to Ray, et al.entitled, “V-Thread Fusion Cage and Method of Fusing a Bone Joint,”discloses a fusion cage with a threaded outer surface, where the crownof the thread is sharp and cuts into the bone. Perforations are providedin valleys between adjacent turns of the thread. The cage can be screwedinto a threaded bore provided in the bone structure at the surgical siteand then packed with bone chips which promote fusion.

U.S. Pat. No. 5,015,247 to Michelson entitled, “Threaded SpinalImplant,” discloses a fusion implant comprising a cylindrical memberhaving a series of threads on the exterior of the cylindrical member forengaging the vertebrae to maintain the implant in place and a pluralityof openings in the cylindrical surface.

U.S. Pat. No. 6,342,074 to Simpson entitled, “Anterior Lumbar UnderbodyFusion Implant and Method For Fusing Adjacent Vertebrae,” discloses aone-piece spinal fusion implant comprising a hollow body having anaccess passage for insertion of bone graft material into theintervertebral space after the implant has been affixed to adjacentvertebrae. The implant provides a pair of screw-receiving passages thatare oppositely inclined relative to a central plane. In one embodiment,the screw-receiving passages enable the head of an orthopaedic screw tobe retained entirely within the access passage.

U.S. Pat. No. 5,885,287 to Bagby entitled, “Self-tapping Interbody BoneImplant,” discloses a bone joining implant with a rigid, implantablebase body having an outer surface with at least one bone bed engagingportion configured for engaging between a pair of bone bodies to bejoined, wherein at least one spline is provided by the bone bed engagingportion, the spline being constructed and arranged to extend outwardlyof the body and having an undercut portion. U.S. Pat. No. 6,582,467 toTeitelbaum et al. entitled, “Expandable Fusion Cage,” discloses anexpandable fusion cage where the surfaces of the cage have multipleportions cut out of the metal to form sharp barbs. As the cage isexpanded, the sharp barbs protrude into the subcortical bone of thevertebrae to secure the cage in place. The cage is filled with bone orbone matrix material.

U.S. Pat. No. 5,800,550 to Sertich entitled, “Interbody Fusion Cage,”discloses a prosthetic device which includes an inert generallyrectangularly shaped support body adapted to be seated on hard endplates of vertebrae. The support body has top and bottom faces. A firstpeg is movably mounted in a first aperture located in the support body,and the first aperture terminates at one of the top and bottom faces ofthe support body. Further, the first peg projects away from the one ofthe top and bottom faces and into an adjacent vertebra to secure thesupport body in place relative to the vertebra.

U.S. Pat. No. 6,436,140 to Liu et al. entitled, “Expandable InterbodyFusion Cage and Method for Insertion,” discloses an expandable hollowinterbody fusion device, wherein the body is divided into a number ofbranches connected to one another at a fixed end and separated at anexpandable end. The expandable cage may be inserted in its substantiallycylindrical form and may be expanded by movement of an expansion memberto establish lordosis of the spine. An expansion member interacts withthe interior surfaces of the device to maintain the cage in the expandedcondition and provide a large internal chamber for receiving bonein-growth material.

These patents all disclose fusion cage devices that can be insertedbetween vertebrae of the spine in an invasive surgical procedure. Suchan invasive surgical procedure requires a long recovery period.

SUMMARY OF THE INVENTION

The present invention is directed to a bone fusion device for insertionbetween bones that are to be fused together, such as, for example, thevertebrae of a spinal column. The bone fusion device comprises at leastone extendable tab and one or more tab extension assemblies. Each tabextension assembly is able to be adjusted in order to individuallycontrol the extension or contraction of a side of the tab therebyenabling adjustment of the height and/or angle of the tab with respectto the body of the bone fusion device. The bone fusion device is in itsmost compact state when the tab is aligned with the body of the devicesuch that the tab lies within the exterior of the body of the device. Inthis compact form, the bone fusion device is preferably inserted betweenthe vertebrae by using an arthroscopic procedure. After the device hasbeen positioned between the vertebrae, the tab is extended using theextension assemblies such that the tab abuts the bottom surface of theupper vertebrae. The angle of the tab with respect to the body of thedevice is able to be adjusted such that it corresponds to the vertebrae.Specifically, each extension assembly is able to be individuallyadjusted such that the side controlled by each assembly is raised orlowered until the desired tab angle is achieved. In this way, the tab isadvantageously positioned and angled to correspond to the vertebrae tohelp brace the device until the bone has fused and to provide a largersurface area to which the bones attach and fuse during a healing period.

A first aspect of the present application is directed to a bone fusiondevice for insertion into a desired location. The device comprises abody having an interior cavity, a tab configured to fit within theinterior cavity and selectively move from a retracted position withininterior cavity of the body to an extended position extending out of thebody and a plurality of extension assemblies coupled to a differentportion of the tab and configured to move the different portions of thetab between the retracted position and the extended position independentof the remainder of the extension assemblies. In some embodiments, eachof the extension assemblies comprise a worm gear operably coupledbetween a drive screw and a support jack such that rotation of the drivescrew rotates the worm gear which retracts or extends the support jackinto or out of the worm gear. In some embodiments, at least one of thedrive screws of the extension assemblies is accessible through a firstlateral side of the body and at least a second one of the drive screwsis accessible through a second lateral side of the body. In someembodiments, the extension assemblies are pivotably coupled to thedifferent portions of the tab such that the tab is able to pivot aboutthe extension assembly. In some embodiments, the body has a bottomsurface and an upper surface, wherein the upper surface is angled withrespect to the bottom surface. In some embodiments, the device furthercomprises one or more plugs, wherein the body and the tab comprise oneor more holes that extend from outside the device to the inner cavityand are configured to be removably filled by the plugs. In someembodiments, the plugs comprise bone material. In some embodiments, thetab comprises one or more tangs positioned along the perimeter of thetop surface of the tab and fit within recesses in the top surface of thebody when the tab is in the retracted position. In some embodiments, oneor more of the tangs extend from the perimeter of the tab to theperimeter of the body. In some embodiments, the device further comprisesa support webbing positioned within the inner cavity of the body betweenone or more walls of the inner cavity and the exterior of the worm gearssuch that the support webbing resists lateral movement of the worm gearswith respect to the walls of the inner cavity.

A second aspect of the present application is directed to a method ofimplanting a bone fusion device into a desired location. The methodcomprises inserting the bone fusion device in the desired location,wherein the bone fusion device comprises a body having an interiorcavity, a tab configured to fit within the interior cavity andselectively move from a retracted position within interior cavity of thebody to an extended position extending out of the body and a pluralityof extension assemblies coupled to a different portion of the tab andconfigured to move the different portions of the tab between theretracted position and the extended position independent of theremainder of the extension assemblies and independently extending one ormore of the different portions of the tab from the retracted positionwithin the interior cavity to a position at least partially outside theinterior cavity by moving at least one of the extension assemblies. Insome embodiments, the method further comprises adjusting the amountwhich one or more of the different portions of the tab are extendedcompared to the remainder of the different portions of the tab such thatthe angle of the tab with respect to the body is adjusted. In someembodiments, each of the extension assemblies comprise a worm gearoperably coupled between a drive screw and a support jack such thatrotation of the drive screw rotates the worm gear which retracts orextends the support jack into or out of the worm gear. In someembodiments, at least one of the drive screws of the extensionassemblies is accessible through a first lateral side of the body and atleast a second one of the drive screws is accessible through a secondlateral side of the body. In some embodiments, the extension assembliesare pivotably coupled to the different portions of the tab such that thetab is able to pivot about the extension assembly. In some embodiments,the body has a bottom surface and an upper surface, wherein the uppersurface is angled with respect to the bottom surface. In someembodiments, the method further comprises removably filling one or moreholes with one or more plugs, wherein the body and the tab comprise theone or more holes, which extend from outside the device to the innercavity and are configured to be removably filled by the plugs. In someembodiments, the plugs comprise bone material. In some embodiments, thetab comprises one or more tangs positioned along the perimeter of thetop surface of the tab and fit within recesses in the top surface of thebody when the tab is in the retracted position. In some embodiments, oneor more of the tangs extend from the perimeter of the tab to theperimeter of the body. In some embodiments, the device further comprisesa support webbing positioned within the inner cavity of the body betweenone or more walls of the inner cavity and the exterior of the worm gearssuch that the support webbing resists lateral movement of the worm gearswith respect to the walls of the inner cavity. In some embodiments, themethod further comprises retracting the tab of the bone fusion deviceinto the retracted position before inserting the bone fusion device intothe desired location.

A third aspect of the present application is directed to a distractioninstrument for use with a bone fusion device. The distraction instrumentcomprises a tubular body, a control rod positioned at least partiallywithin the tubular body, wherein the control rod comprises a first endcoupled with a handle and extending out a first side of the tubular bodyand a second end including an engaging element and extending out asecond side of the tubular body and a head assembly comprising aplurality of plates and operably coupled with engaging element of thecontrol rod such that manipulating the control rod with respect to thehead assembly causes the plates to separate. In some embodiments, thehead assembly is operably coupled with the engaging element such thatrotation of the control rod with respect to the head assembly causes theplates to separate and rotation in the opposite direction causes theplates to contract. In some embodiments, the head assembly furthercomprises a jack mechanism coupled between the plates that effectuatesthe separating and the contracting of the plates and is configured tofit within one or more recesses within the plates when the plates arefully contracted. In some embodiments, the instrument further comprisesan indicator positioned on the surface of the instrument, wherein theindicator dynamically indicates the distance between the plates. In someembodiments, the indicator indicates one or more values corresponding tohow much one or more controls of one or more bone fusion implant devicesmust be rotated to extend one or more tabs of the devices such that thedevices have height equal to the distance between the plates. In someembodiments, the instrument further comprises a force sensor coupled tothe head assembly, wherein the force sensor measures a level of forceresisting the separation of the plates. In some embodiments, theindicator indicates the level of force measured by the force sensor. Insome embodiments, the head assembly is configured to stop the platesfrom further separating once the level of force measured by the forcesensor equals a threshold level. In some embodiments, the instrumentfurther comprises a motor and a motor control coupled with the controlrod, wherein the motor control controls the operation of the motor andthe motor enables motorized manipulation of the control rod to separatethe plates.

A fourth aspect of the present application is directed to a method ofusing a distraction instrument to measure the amount of space in adesired location. The method comprises inserting the distractioninstrument in the desired location, wherein the distraction instrumentcomprises a tubular body, a control rod positioned at least partiallywithin the tubular body, wherein the control rod comprises a first endcoupled with a handle and extending out a first side of the tubular bodyand a second end including an engaging element and extending out asecond side of the tubular body and a head assembly comprising aplurality of plates and operably coupled with engaging element of thecontrol rod such that moving the control rod with respect to the headassembly causes the plates to separate and separating the plates untilthe plates reach bounds of the desired location by manipulating thecontrol rod with respect to the head assembly. In some embodiments, themanipulating the control rod comprises rotating the control rod withrespect to the head assembly wherein rotation in a first directioncauses the plates to separate and rotation in a second direction causesthe plates to contract. In some embodiments, the head assembly furthercomprises a jack mechanism coupled between the plates that effectuatesthe separating and the contracting of the plates and is configured tofit within one or more recesses within the plates when the plates arefully contracted. In some embodiments, the instrument further comprisesan indicator positioned on the surface of the instrument, wherein theindicator dynamically indicates the distance between the plates. In someembodiments, the indicator indicates one or more values corresponding tohow much one or more controls of one or more bone fusion implant devicesmust be rotated to extend one or more tabs of the devices such that thedevices have height equal to the distance between the plates. In someembodiments, the instrument further comprises a force sensor coupled tothe head assembly, wherein the force sensor measures a level of forceresisting the separation of the plates. In some embodiments, theindicator indicates the level of force measured by the force sensor. Insome embodiments, the head assembly is configured to stop the platesfrom further separating once the level of force measured by the forcesensor equals a threshold level. In some embodiments, the instrumentfurther comprises a motor and a motor control coupled with the controlrod, wherein the motor control controls the operation of the motor andthe motor enables motorized manipulation of the control rod to separatethe plates.

A fifth aspect of the present application is directed to a bone fusiondevice for insertion into a desired location. The device comprises abody having an interior cavity, a tab configured to fit within theinterior cavity and selectively move from a retracted position withininterior cavity of the body to an extended position extending out of thebody, a plurality of extension assemblies coupled to a different portionof the tab and configured to move the tab between the retracted positionand the extended position and a position locking mechanism operablycoupled with each of the plurality of extension assemblies andconfigured to provide a plurality of locking positions that theplurality of extension assemblies are biased to stay in by the positionlocking mechanism. In some embodiments, the plurality of extensionassemblies are configured to move the different portions of the tabbetween the retracted position and the extended position independent ofthe remainder of the extension assemblies. In some embodiments, theposition locking mechanism comprises a dial operably coupled with one ofthe plurality of extension assemblies such that when the one of theplurality of extension assemblies is rotated the dial is also rotated.In some embodiments, the position locking mechanism comprises one ormore stops operably coupled with the dial such that when the one of theplurality of extension assemblies is in one of the locking positions theinterface between the dial and the stops provides a biasing force thatresists the movement of the one of the plurality of extension assembliesout of the one of the locking positions.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates an external perspective view of a bone fusion deviceaccording to some embodiments.

FIG. 1B illustrates an internal perspective view of a bone fusion deviceaccording to some embodiments.

FIG. 2 illustrates a perspective view of the components of the bonefusion device according to some embodiments.

FIG. 3A illustrates a cross sectional view of the bone fusion devicewith the tab retracted according to some embodiments.

FIG. 3B illustrates a cross sectional view of the bone fusion devicewith the tab extended according to some embodiments.

FIG. 4 illustrates a flow chart of a method of operating the bone fusiondevice according to some embodiments.

FIG. 5 illustrates the bone fusion device comprising one or more boneplugs according to some embodiments.

FIG. 6A illustrates a frontal view of a bone fusion device according tosome embodiments.

FIG. 6B illustrates a side view of a bone fusion device according tosome embodiments.

FIG. 6C illustrates a top view of an elongated member inserted within acanal of a bone fusion device according to some embodiments.

FIG. 6D illustrates a frontal and profile view of an elongated memberaccording to some embodiments.

FIG. 6E illustrates a front view of the bone fusion device having one ormore tangs according to some embodiments.

FIG. 6F illustrates a profile view of the bone fusion device having oneor more tangs according to some embodiments.

FIG. 6G illustrates a top view of the bone fusion device having one ormore tangs according to some embodiments.

FIG. 7 illustrates a flowchart directed to a method of using the bonefusion system according to some embodiments.

FIG. 8A illustrates a top view of a bone fusion device according to someembodiments.

FIG. 8B illustrates a top view of a bone fusion device according to someembodiments.

FIG. 8C illustrates a top view of a bone fusion device according to someembodiments.

FIG. 8D illustrates a top and perspective view of a bone fusion deviceaccording to some embodiments.

FIG. 8E illustrates a top and perspective view of a bone fusion deviceaccording to some embodiments.

FIG. 8F illustrates a top and perspective view of a bone fusion deviceaccording to some embodiments.

FIG. 8G illustrates a perspective view of a bone fusion device accordingto some embodiments.

FIG. 9 illustrates a cross sectional perspective view of a bone fusiondevice having one or more angled drive screws according to someembodiments.

FIG. 10 illustrates a flowchart directed to a method of using a bonefusion device according to some embodiments.

FIG. 11 illustrates a flowchart directed to a method of using a bonefusion device according to some embodiments.

FIG. 12 illustrates a perspective view of a distraction instrument formeasuring the space to be filled by a bone fusion device according tosome embodiments.

FIG. 13 illustrates a top cross sectional view of the distraction bodyaccording to some embodiments.

FIG. 14 illustrates a perspective view of the components of theretraction head of the retraction instrument according to someembodiments.

FIG. 15A illustrates cross sectional view of the head of the retractioninstrument with the plates fully retracted according to someembodiments.

FIG. 15B illustrates cross sectional view of the head of the retractioninstrument with the plates fully extended according to some embodiments.

FIG. 16 illustrates a flow chart of a method of operating the retractioninstrument according to some embodiments.

FIG. 17A illustrates a top view of the bone fusion device comprising awebbing according to some embodiments.

FIG. 17B illustrates a cross-sectional side view of the bone fusiondevice comprising a webbing according to some embodiments.

FIG. 18A illustrates a perspective view of a bone fusion systemaccording to some embodiments.

FIG. 18B illustrates a perspective view of a bone fusion systemaccording to some embodiments.

FIG. 19 illustrates a perspective view of a bone grafting material bagaccording to some embodiments.

FIG. 20 illustrates a flowchart directed to a method of using the bonefusion system according to some embodiments.

FIG. 21A illustrates a bone fusion device with a tab configured to havethe maximum parallel distraction according to some embodiments.

FIG. 21B illustrates a bone fusion device with a tab configured to havethe maximum angle according to some embodiments.

FIG. 22 illustrates a bone fusion device having a position lockingmechanism according to some embodiments.

DETAILED DESCRIPTION

In the following description, numerous details and alternatives are setforth for purpose of explanation. However, one of ordinary skill in theart will realize that the invention can be practiced without the use ofthese specific details. For instance, the figures and description belowoften refer to the vertebral bones of a spinal column. However, one ofordinary skill in the art will recognize that some embodiments of theinvention are practiced for the fusion of other bones, including brokenbones and/or joints. In other instances, well-known structures anddevices are shown in block diagram form in order not to obscure thedescription of the invention with unnecessary detail. Further, althoughthe figures and description below refer to a bone fusion device having asingle tab and a pair of tab extension assemblies, it is understood thatthe bone fusion device is able to comprise multiple tabs each having anynumber of tab extension assemblies.

FIGS. 1A and 1B illustrate an external and internal perspective view ofa bone fusion device 100 according to some embodiments. As shown inFIGS. 1A and 1B, the bone fusion device 100 comprises a body 102, atleast one tab 104 and a plurality of tab extension assemblies eachcomprising a drive screw 106A, 106B, a gear 108A, 108B and a supportingjack 110A, 110B. Alternatively, the device 100 is able to comprise asingle tab extension assembly. The front tab extension assemblycomprises a front drive screw 106A which is mechanically coupled to afront supporting jack 110A via a front gear 108A, and the back tabextension assembly comprises a rear drive screw 106B which ismechanically coupled to a rear supporting jack 110B via a rear gear108B. As a result, the supporting jacks 110A, 110B are able to beindividually and selectively raised or lowered with respect to the gears108A, 108B by rotating or otherwise manipulating the corresponding drivescrews 106A, 106B of the extension assemblies. As shown in FIG. 1A, whencombined with the body 102 and tab 104, the drive screws 106A, 106B areable to be positioned within a pair of screw channels 204 of the body102 (see FIG. 2 ) and the supporting jacks 110A, 110B are able to couplewith the jack holes 208 at the front and rear of the tab 104.Accordingly, by accessing and adjusting the drive screws 106A, 106B ofthe tab extension assemblies through the screw channels 204 of the body102, a user is able to not only selectively extend and retract the tab104 a desired distance from the body 102, but also is able to adjust theangle of the tab 104 by lowering or raising the sides of the tab 104with respect to each other. Alternatively, the tab extension assembliesare able to comprise other components for selectively raising orlowering the tab 104 such as a plurality of angled extending blocks thatare able to be individually controlled by drive screws such that theypress against the tab 104 to selectively extend/retract and adjust theangle of the tab 104.

The bone fusion device 100 is able to be constructed from a highstrength biocompatible material, such as titanium, which has thestrength to withstand forces in the spine that are generated by apatient's body weight and daily movements. Alternatively, part or all ofthe bone fusion device 100 is able to be constructed from one or more ofthe group consisting of ceramics, high strength biocompatible material,a polymer such as PEEK, PEKK and other polymeric materials, stainlesssteel, titanium, titanium alloys such as nitinol and other biocompatiblemetals. In some embodiments, the materials used to construct the bonefusion device include using additives, such as carbon fibers for betterperformance of the materials under various circumstances. The basebiocompatible material is often textured or coated with a porousmaterial conducive to the growth of new bone cells on the bone fusiondevice 100.

It should be noted that although FIGS. 1A and 1B illustrate a single tab104 having a pair of extension assemblies, the bone fusion device 100 isable to comprise any number of tabs 104 each having any number ofextension assemblies. Further, although the extension assemblies areshown as coupling to a front end and a back end of the tab 104, theassemblies are able to be coupled to any portion of the tab 104 suchthat the angle of the tab 104 in any plane is able to be adjusted usingthe extension assemblies. In particular, for each tab extension assemblycoupled to a tab 104, another side or portion of the tab 104 is able tobe selectively raised or lowered with respect to the body 102 and/orother portions of the tab 104.

FIG. 2 illustrates a perspective view of the components of the bonefusion device 100 according to some embodiments. As shown in FIG. 2 ,the body 102 comprises a body cavity 202 for housing the othercomponents in a retracted state, one or more screw channels 204 forreceiving the drive screws 106A, 106B, and one or more body apertures206 for providing access to the cavity 202. Specifically, the body 102houses the tab 104 and tab extension assemblies within the body cavity202 such that when the device 100 is in a retracted state the tab 104and tab extension assemblies are all positioned within the outerdimensions of the body 102. This enables the bone fusion device 100 tohave the smallest profile possible when in the tab 104 is retractedthereby minimizing the size of the required surgical incision for thebone fusion surgery.

In some embodiments, the body 102 has a substantially rectangularstructure with an angled upper surface that aligns with the uppersurface of the tab 104 when the tab 104 is retracted. In someembodiments, the upper surface of the body 102 is angled downward fromfront to back such that the front wall is higher than the back wall.Alternatively, the upper surface of the body 102 is able to be angledupward from front to back and/or otherwise angled. Alternatively, thebody 102 is able to comprise other shapes such as shapes thatsubstantially conform to the shape of vertebrae. In some embodiments,the screw channels 204 positioned such that the screws 106A, 106B areaccessible from the same side of the body 102. Alternatively, thechannels 204 are able to be positioned such that the screws 106A, 106Bare accessible from one or more different sides of the body 102. Theapertures 206 of the body 102 extend from the cavity 202 to the exteriorof the body 102. As a result, the apertures 206 permit bone graftmaterial to be inserted into the device 100 and to contact the vertebralbone before or after the device 100 has been inserted between thevertebrae of the patient. As used herein, bone graft material is able torefer to materials, biologics or other structures that promoteosteoinduction and/or osteoconduction as are well known in the art. Forexample, the bone graft material is able to comprise, in combination orseparately, one or more of autologous bone, allograft bone, artificialbone paste, artificial bone putty, osteoinduction material,osteoconduction material or other “scaffolding” for bone to grow uponand to induce bone growth as are well known in the art. The bone graftmaterial and the surface texturing of the device 100 encourage thegrowth and fusion of bone from the neighboring vertebrae. The fusion andhealing process will result in the bone fusion device 100 aiding in thebridging of the bone between the two adjacent vertebral bodies of thespine which eventually fuse together during the healing period.Additionally, it is understood that although as shown in FIG. 2 , thebody 102 comprises a single aperture 206 positioned on a rear surface,the body 102 is able to comprise any number of apertures 206 positionedon any of the surfaces of the body 102.

In some embodiments, the body 102 of the bone fusion device 100comprises one or more gripping channels (not shown) each having at leastone gripping aperture. In such embodiments, the gripping apertures areable to receive the gripping fingers of a bone fusion device insertioninstrument such that the instrument cannot slip out of place duringoperation. In particular, the gripping channels and insertion instrumentare able to be substantially similar in operation and structure to thebone fusion device channels and bone fusion device insertion instrumentdescribed in U.S. Provisional Application No. 61/521,681, filed Aug. 9,2011 and entitled “BONE FUSION DEVICE, APPARATUS AND METHOD,” which ishereby incorporated by reference. As a result, an insertion instrumentis able to grip and insert the bone fusion device 100 while preventingor at least minimizing the risk of the insertion instrument and/or bondfusion device 100 slipping out of place. Indeed, this security isnecessary to ensure that the surgeon is able to precisely place andcontrol the device 100 within a patient during surgery.

As shown in FIG. 2 , the tab 104 comprises one or more tab apertures 210and one or more jack holes 208 such that there is at least one jack hole208 for each jack 110A, 110B. Specifically, the jack holes 208 arepositioned and sized such that the ends of the jack heads 224 of thejacks 110A, 110B are able to couple to the tab 104 by being positionedwithin the jack holes 208. For example, in some embodiments a pair ofjack holes 208 are able to be positioned across from each other on thetab 104 such that the holes 208 straddle each jack head 224 preventingthe jack 110A, 110B from separating from the tab 104. In someembodiments, the jack holes 208 (and at least a portion of the profileof the jack heads 224) are substantially circular such that when coupledto the jacks 110A, 110B, the jacks 110A, 110B are able to rotate withinthe jack holes 208 with respect to the tab 104. In particular, thisrotational coupling provides the advantage of enabling the angle of tab104 with respect to the body 102 and/or extension assemblies to beadjusted because the rotation of the jacks 110A, 110B within the holes208 corresponds to the angle change of the tab 104 with respect to thebody 102 and/or assemblies. Alternatively, the jack holes 208 and jackheads 224 are able to comprise ball joints or other shapes and/orprofiles that enable both coupling and rotation as are well known in theart.

The tab 104 is shaped such that the tab 104 is able to fit within thecavity 202 of the body 102. For example, in some embodiments the tab 104is shaped such that its perimeter profile matches the perimeter of thecavity 202 and/or such that the outwardly facing surface of the tab 104is substantially flush with the frame 114 of the bone fusion device 100when the tab 104 is in the retracted position. In some embodiments, theupper surface of the tab 104 is angled downward from front to back suchthat the front wall is higher than the back wall. Alternatively, theupper surface of the tab 104 is able to be angled upward from front toback and/or otherwise angled. Alternatively, the tab 104 is able tocomprise other shapes as are well known in the art. In some embodiments,tabs 104 having upper surfaces of varying angles are able to beinterchanged within the bone fusion device 100. As a result, a user isable to exchange the current tab 104 of a device 100 with a differenttab 104 having a differently angled upper surface. This allows the samebone fusion device 100 to be switched from having the maximum paralleldistraction 120 with a tab 104 with a parallel upper surface as shown inFIG. 21A to the maximum angle 122 with a tab 104 having the maximumangled upper surface as shown in FIG. 21B or angles in between. In someembodiments, the outwardly facing surface of the tab 104 has sharpserrated edges, protrusions, ridges or threads along the length of thetab 104 for engaging the adjacent vertebrae. Further, it is understoodthat although as shown in FIG. 2 , the tab 104 comprises a single tabaperture 210 positioned on an upper surface, the tab 104 is able tocomprise any number of tab apertures 210 positioned on any of thesurfaces of the tab 104.

As shown in FIG. 2 , the drive screws 106A, 106B each comprise apositioning aperture 214, a threaded portion 212 and a recessed portion216, the gears 108A, 108B each comprise gear teeth 218 and interiorthreading 220, and the jacks 110A, 110B each comprise a jack head 224,exterior threading 222 and a bottom protrusion 226. Specifically, asshown in FIG. 1B, the threaded portion 212 of the drive screws 106A,106B is positioned such that the threads align with the gear teeth 218of one of the gears 108A, 108B and the interior threading 220 of thegears 108A, 108B matches the exterior threading 222 of the jack heads224 when the jack heads 224 are positioned within the gears 108A, 108B.As a result, when the drive screws 106A, 106B are rotated, the threadedportion 212 applies force to the gear teeth 218 rotating the interiorthreading 220 of the gears 108A, 108B. This rotation causes the interiorthreading to apply force to the exterior threading 222 of the jacks110A, 110B causing the jacks 110A, 110B to extend out of or retractfurther within the gears 108A, 108B. In particular, if the screws 106A,106B are rotated in a first direction, the jacks 110A, 110B are extendedout of the gears 108A, 108B until the bottom protrusion 226 reaches theinterior threading 220 (see FIG. 3B). Conversely, if the screws 106A,106B are rotated in an opposite second direction, the jacks 110A, 110Bare retracted further within the gears 108A, 108B until the bottom ofthe jack heads 224 abut the upper surface of the gears 108A, 108B (seeFIG. 3A). Thus, when coupled to the tab 104, by rotating the drivescrews 106A, 106B, the tab extension assemblies are able to selectivelyretract/extend and adjust the angle of the tab 104 with respect to thebody 102. Alternatively, one or more of the drive screws 106A, 106B,gears 108A, 108B and/or jacks 110A, 110B are able to be mechanicallycoupled using other mechanically coupling components as are well knownin the art. For example, a universal joint is able to be used instead ofthe threaded portion 212 and gear teeth 218 in order to translate therotation of the drive screws 106A, 106B to the gears 108A 108B.

The positioning apertures 214 of the drive screws 106A, 106B arepositioned on the end of the screws 106A, 106B such that they areaccessible when the drive screws 106A, 106B are within the screwchannels 204 of the body 102. As a result, a user is able to insert oneor more tool engaging members (not shown) into the positioning apertures214 in order to rotate the drive screws 106A, 106B. The structure of thepositioning apertures 214 is configured such that the structure enablesone or more engaging members of tools to rotate the drive screws 106A,106B. For example, the positioning apertures 214 are able to match theengaging members of allen wrenches, flat-head screw drivers, phillipsscrew drivers and/or the engaging members of other types of tools as arewell known in the art. The recessed portions 216 of the drive screws106A, 106B are positioned such that they are adjacent to and/or surroundthe gear 108A, 108B that is not mechanically coupled to the threadedportion 212 of that drive screw 106A, 106B. As a result, the recessedportions 216 are able to help hold the gears 108A, 108B and screws 106A,106B in place with respect to each other while not translating therotation of the screws 106A, 106B to the gear 108A, 108B of the othertab extension assembly. Alternatively, the recessed portions 216 areable to be omitted. For example, the recessed portions 216 are able tobe omitted and the threaded portion 212 is able to protrude out from thecylindrical body of the screws 106A, 106B in order to maintainmechanical coupling with the gear teeth 218. In some embodiment, thebody 102 further comprises one or more tool channels (not shown) thatselectively couple with a tool when the engaging member of the tool iscoupled with one or more of the positioning apertures 214. As a result,the tool and its engaging member is able to be prevented from slippingout of the positioning apertures 214 which is able to cause harm to apatient during an insertion procedure.

FIGS. 3A and 3B illustrate cross sectional view of the bone fusiondevice 100 with the tab 104 fully retracted and fully extended,respectively, according to some embodiments. As shown in FIG. 3A, whenthe device is in the retracted position, the jacks 110A, 110B are fullyretracted within the gears 108A, 108B and the outward facing surface ofthe tab 106 is substantially flush with the upper surface of the body102. While in this position, the bone fusion device 100 creates thesmallest profile possible and thus is able to be surgically insertedbetween two vertebrae of a patient with a minimally invasive procedure.As shown in FIG. 3B, once in position, the surgeon is able to use one ormore tools (not shown) to rotate the drive screws 106A, 106B of the tabextension assemblies until the tab 104 has been raised to a desiredheight by the jacks 110A, 110B. Further, the surgeon is able toindividually raise or lower the jacks 110A, 110B such that the tab 104is rotated and the upper angle of the tab 104 with respect to the body102 is adjusted. Accordingly, the bone fusion device 100 provides theadvantage of enabling not only the tab height to be adjusted to adesired level, but also that the tab angle to be adjusted to a desireddegree in order to best correspond to the vertebrae thereby increasingthe stability of the bone fusion and the success of the surgery.

FIG. 5 illustrates the bone fusion device 100 comprising one or morebone plugs 500 according to some embodiments. As shown in FIG. 5 , thebone plugs 500 comprise a plug body 502 having at least one desiredprofile or perimeter 504. Specifically, the perimeter 504 of the plugbody 502 is sized such that the plug 500 fits within one or more of thetab 104 or body 102 apertures 210, 206. As a result, one or more boneplugs 500 are able to be used to fill one or more of the apertures ofthe bone fusion device 100. This creates the benefit of reducing theamount of bone graft material that needs to be inserted into the cavity202 of the bone fusion device 100. In some embodiments, the bone fusiondevice 100 comprises at least one bone plug 500 for each aperture withinthe body 102 and/or the tab 104. Alternatively, at least one of theapertures within the body 102 and/or the tab 104 are able to remain“unplugged” such that bone graft material is able to be injected intothe device 100 through the unplugged apertures. In some embodiments, thebone plugs 500 are sized such that the perimeter 504 will contact theinner surface of the apertures 210, 206 when the bone plug 500 isinserted into the aperture such that friction from the contact will holdthe plug 500 in place. In some embodiments, the perimeter 504 is able tobe sized slightly larger than the inner surface of the apertures 210,206 such that upon insertion into an aperture either the aperture or theplug 500 flexes, wherein the resistance to the flexing provides a forceholding the plug or plugs 500 in place within the aperture.Alternatively, the plugs 500 are able to have differently shapedperimeters 504 as are well known in the art.

In some embodiments, the body 502 of one or more of the plugs 500 has athickness greater than the thickness of the apertures 206, 210 such thatthe plugs 500 are able to protrude into and/or out of the bone fusiondevice 100 when positioned within one of the apertures 206, 210.Alternatively, the body 502 is able to be less thick and/or bepositioned such that body 502 aligns with the surface of the bone fusiondevice 100 when inserted in an aperture 206, 210. In some embodiments,the body 502 of the plugs 500 comprises bone. Alternatively, the body502 is able to comprise one or more materials selected from the groupconsisting of bone, bone graft material capable of retaining a desiredshape, bone-like substances known to aid in the fusion process and otherbiocompatible materials as are well known in the art. In someembodiments, the one or more of the plugs 500 are flexible.Alternatively, the plugs 500 are able to be inflexible or rigid.Although the bone plugs 500 are described in reference to the bonefusion device 100, it is understood that they are able to be sized inorder to fill the apertures of other types of bone fusion devices.

FIG. 4 illustrates a flow chart of a method of operating the bone fusiondevice 100 according to some embodiments. A user rotates one or more ofthe drive screws 106A, 106B of the tab extension assemblies until thetab 104 is in a fully retracted position at the step 402. The userinserts the bone fusion device 100 into the desired position within thepatient at the step 404. In some embodiments, the desired positioncomprises between or adjacent to one or more vertebrae. In someembodiments, the bone fusion device 100 is inserted anteriorly.Alternatively, the bone fusion device 100 is able to be insertedposteriorly, laterally, far lateral, extra lateral, extreme lateral,transforaminaly, or other directions as are well known in the art. Theuser rotates one or more of the drive screws 106A, 106B of the tabextension assemblies until the tab 104 is extended to a desired heightat the step 406. In some embodiments, the desired height comprises theheight required such that the tab 104 abuts the vertebrae. The userrotates one or more of the drive screws 106A, 106B of the tab extensionassemblies until the tab 104 is rotated to a desired angle at the step408. In some embodiments, the device 100 comprises a single tabextension assembly such that only the drive screw or screws associatedwith the single tab extension assembly need to be rotated. In someembodiments, the desired angle comprises the angle required to cause theoutward facing surface of the tab 104 to substantially match the angleof the surface of the adjacent vertebrae. In some embodiments, the angleof the surface of the tab 104 is able to be adjusted before and/orduring the extension of the tab 104 to the desired height. As a result,the tab 104 and the remainder of the bone fusion device 100 is able toexert a satisfactory force between the bone fusion device and the bonesto be fused. At that point the bone fusion device 100 is able to remainin place. Thereafter, in some embodiments, material, such as autograftmaterial, for fusing the bones together is able to be inserted throughthe apertures 206, 210 of the bone fusion device 100 to promote healing.Alternatively, the insertion of the material is able to be omitted oroccur before insertion of the bone fusion device 100. In someembodiments, the method is able to comprise a plurality of bone fusiondevices 100 that are each able to be used as described herein. In suchembodiments, the plurality of bone fusion devices 100 are able to beinserted and/or adjusted together or separately. Alternatively, a singlebone fusion device 100 is able to be used. For example, a single bonefusion device 100 is able to be used for a cervical surgery operation.Therefore, the bone fusion device 100 provides the advantage of a smallincision and minimally invasive (arthroscopic) surgical procedure whichadvantageously promotes health and rapid recovery by the patient.Preferably, bone growth occurs around the bone fusion device andparticularly at the location of the extended tab, such that the bonefusion device is further secured by the bone growth, which furtherpromotes a superior, robust bone fusion result.

FIGS. 6A-C illustrate a front, side and top view of a bone fusion device600 having one or more canals 621 according to some embodiments. Thebone fusion device 600 shown in FIGS. 6A-C is substantially similar tothe bone fusion device 100 except for the differences described herein.In particular, the bone fusion device 600 comprises a body 614 havingone or more canals 621 and one or more tabs 630. In some embodiments,the canals 621 are positioned along the sides of the body 614 and asized such that the canals 621 are able to receive or house a portion orall of one or more elongated members 623 (see FIG. 6D). Alternatively,one or more of the canals 621 are able to be positioned within otherportions of the body 614 including different angles and orientations inone or all axises of the bone fusion device 600. Alternatively, one ormore of the canals 621 are able to be positioned within one or more ofthe tabs 630. In some embodiments, the canals 621 extend from a centralarea of the body 614 to the front or back side of the body 614 such thatan elongated member 623 is able to enter the canals 621 from the frontor back side of the body 614 (and/or the side of the body 614).Alternatively, one or more of the canals 621 extend along the entirebone fusion device 600 from the front side to the back side of the body614 (or vice versa), such that an elongated member 623 is able to enterthe canals 621 from both or either the front or back side of the body614. Alternatively, one or more of the canals 621 are able to be housedentirely within an inner portion of the body 614 such that the canals621 breach neither the front nor the back side of the body 614 and theelongated members 623 are only able to enter the canals 621 from theside of the body 614.

FIG. 6C illustrates a top view of an elongated member 623 insertedwithin a canal 621 of the bone fusion device 600 according to someembodiments. As shown in FIG. 6C, the elongated member 623 is curved andextends from the front of the body 614 and canal 621 to a centralportion of the body 614. Alternatively, the elongated members 623 areable to be configured such that the members 623 extend to the front,back, or other portions of the body 614. In some embodiments, one ormore of the elongated member 621 are able to extend out of the canals621 into the central cavity of the body 614 and/or outside of the body614. For example, the members 623 are able to be curved or otherwiseshaped such that the members 623 enter a desired portion of the body 614while not extending out of the side of the body 614 more than a desireddistance (e.g. 1 mm). In some embodiments, the desired portion of thebody 614 in which the members 623 are positioned comprise between thefront or back side of the body 614. Alternatively, the members 623 areable to be configured such that the members 623 are able to remainentirely within the canals 621 and/or cavity of the body 614.Additionally, it should be noted that one or more of the components ofthe bone fusion device 600 is able to be incorporated into the otherbone fusion devices described herein.

FIG. 6D illustrates a frontal and profile view of an elongated member623 according to some embodiments. As shown in FIG. 6D, the elongatedmember 623 comprises a body 625 and one or more apertures 627. The body625 is sized such that the member 623 is able to partially or wholly fitwithin the canals 621. In some embodiments, the body 625 is able to betubular such that material, such as autograft material, is able to beinserted into the body 625 via the apertures 627. Alternatively, thebody 625 is able to be partially or wholly solid, wherein if the body625 is wholly solid the apertures 627 are able to be omitted.Alternatively, the body 625 is able to comprise other solid or hollowshapes as are well known in the art. As shown in FIG. 6D, the body 625of the elongated member 623 is substantially straight. Alternatively,the body 625 is able to comprise one or more curves and/or corners asare well known in the art. For example, as shown in FIG. 6C, the body625 is able to be curved such that the member 623 is able to curve fromthe canal 621 into the cavity of the body 614 of the bone fusion device600. In some embodiments, the elongated member 623 is able to bebendable such that body 625 is able to be bended to a desired shape by auser and the body 625 will retain the desired shape. In someembodiments, the body 625 is filled with one or more of calciumtriphosphate, hydroxyapatite or other materials that are constituents ofbone or promote bone growth as are well known in the art. In someembodiments, the body 625 is able to comprise materials that areconstituents of bone or promote bone growth as are well known in theart. Alternatively, the body 625 is able to comprise the same or similarmaterials to that of the bone fusion device 600. As a result, the bonefusion device 600 and the elongated members 623 are able to be used toposition bone grafting promotive material along the device 600 after thebone fusion device 600 has been positioned into place within a patient.This enables the bone fusion device 600 to ensure that the bone fusionmaterial is not pushed out of place during the extension of the tabs 630or other portions of the procedure.

FIGS. 6E-G illustrate a front, profile and top view of the bone fusiondevice 2400 having one or more tangs 2406 according to some embodiments.The bone fusion device 2400 shown in FIGS. 6E-G is substantially similarto the bone fusion device 100 except for the differences describedherein. In particular, the bone fusion device 2400 comprises a body 2402having one or more tang recesses 2408 and one or more tabs 2404 havingone or more tangs 2406. The tangs 2406 extend from one or more of thetabs 2404 and increase the surface area of the tabs 2404 therebypromoting bone growth and aiding the fusion process. The tang recesses2408 are sized and positioned to receive or house each of the tangs 2406when the tabs 2404 are retracted into the body 2402 in order to maintainthe minimal size of the device 2400 when in the retracted position. Insome embodiments, each tang 2406 has a separate corresponding tangrecess 2408. Alternatively, one or more of the tang recesses 2408 areable to house a plurality of tangs 2406. In some embodiments, the tangs2406 are positioned around the top perimeter of one or more of the tabs2404. Alternatively, the tangs 2406 are able to be positioned elsewhereon one or more of the tabs 2404 such that the tangs 2406 are able toincrease the surface area of the tabs 2404. In some embodiments, one ormore of the tangs 2406 are able to extend beyond the perimeter of thebody 2402. In such embodiments, when the tab 2404 is retracted withinthe body 2402, a portion of the extended tangs 2406 would be housedwithin the tang recesses 2408 and a portion of the tangs 2406 wouldprotrude out of the tang recesses 2408 beyond the perimeter of the body2402. Although the tangs 2406 and tang recesses 2408 are described inreference to the bone fusion device 2400, it is understood that they areable to be incorporated into the other bone fusion devices describedherein.

A method of using the bone fusion device 600 according to someembodiments is illustrated by the flow chart in FIG. 7 . A user selectsone or more elongated members 623 based on the shape and size of theelongated members 623 at the step 702. Alternatively, the user selectsone or more elongated members 623 and bends them into a desired shapeand size. The user fills one or more of the selected elongated members623 with bone grafting material at the step 704. The user positions thebone fusion device 600 within the patient at the step 706. The userinserts the one or more elongated members 623 within and/or outside thecanals 621 and/or body 614 of the bone fusion device 600 at the step708. Alternatively, one or more of the elongated members 623 are able tobe positioned within and/or outside of the canals 621 before or duringthe positioning of the bone fusion device 600 within the patient. Thus,the method of using the bone fusion system provides the advantage ofallowing the bone grafting material to be packed into the elongatedmembers 623 and positioned after the positioning of the bone fusiondevice 600 within the patient. As a result, the bone fusion device 600is able to prevent the elongated members 623 from being moved during thepositioning of the bone fusion device within the patient thereby keepingthe bone grafting material in the desired position and/or shape withrespect to the adjacent bones and bone fusion device 600 such thatquicker and stronger bone fusion is promoted speeding up the healingprocess. In some embodiments, one or more of the steps of the abovemethod are able to be omitted or combined with the other methodsdescribed herein.

FIGS. 8A-8G illustrate top and perspective views of a bone fusion device800 according to some embodiments. Although one or more of thecomponents discussed above are omitted, the bone fusion devices 800shown in FIGS. 8A-8G are substantially similar to the bone fusion device100 except for the differences described herein. As shown in FIGS.8A-8G, the bone fusion device 800 comprises drive screws 808 one or moretabs 830 and a body/frame 814. Specifically, the body 814 comprises anoval shaped (FIG. 8A), kidney shaped (FIG. 8B), round shaped (FIG. 8C),rectangular shaped (FIG. 8D), banana shaped (FIG. 8E) or otherwiseshaped (FIG. 8F) top/bottom profile such that the shape of thetop/bottom profile of the body 814 is substantially similar to the shapeof the horizontal profile of one or more vertebrae. Alternatively, thetop/bottom profile of the body 814 is able to comprise one or more othershapes that substantially match bones that are to be fused to the bonefusion device 800. Alternatively, the top profile of the tabs 830 areable to be shaped as described herein, wherein the body 814 remains thestandard shape as described above. In some embodiments, the top profileof the tabs 830 are shaped substantially similar to the top/bottomprofile of the body 814. For example, as shown in FIGS. 8D-8F, the tabs830 have rounded edges to match the perimeter of the frames 814.Alternatively, the top profile of the tabs 830 is able to comprise othershapes as are well known in the art. In some embodiments, the topprofile shapes of the body 814 are between 15 and 25 mm along theanterior/posterior axis and between 20 and 45 mm along the lateral axis.Alternatively, other dimensions are envisioned. For example, for bonefusion devices designed for cervical spinal bones, the body 814 is ableto be less than 15 mm along the anterior/posterior axis and less then 20mm along the lateral axis. Alternatively, the body 814 is able to be 55mm or longer along the lateral axis (typically for extreme laterallumbar interbody fusion). In some embodiments, the body 814 and/or tab830 have an angled upper surface such that the angle of the bone fusiondevice 800 matches the angle between the vertebrae. In some embodiments,the angle is equal to 15 degrees. Alternatively, other angles are ableto be utilized. In some embodiments, as shown in FIG. 8G, the drivescrews 808 are able to be non-parallel with the elongated topdimension/axis 815 of the body 814.

As a result, the bone fusion device 800 provides the advantage ofsubstantially matching the horizontal profiles of the bones to be fused,thereby increasing the strength and efficiency of the fusion process.Further, the profile shapes provide the advantage of enabling a user toselect a bone fusion device 800 with a top profile shape whoseorientation matches the insertion orientation of the operation.Additionally, the angles at which the drive screws 808 are oriented withrespect to the elongated axis 815 of the body 814 is able to be selectedto match the angle of access provided by a desired operation. As aresult, the bone fusion device 800 does not need to be turned to be inthe proper orientation between the bones of the patient whether theprocedure is anterior, posterior, lateral, far-lateral or transforaminallumbar interbody fusion. Moreover, the upper surface angles provide theadvantage of enabling a user to select a bone fusion device 800 with abody 814 and/or tab 830 angle that matches the angle between the targetvertebrae.

FIG. 9 illustrates a cross sectional perspective view of a bone fusiondevice 900 having one or more angled drive screws according to someembodiments. The bone fusion device 900 shown in FIG. 9 is substantiallysimilar to the bone fusion device 100 except for the differencesdescribed herein. Specifically, as shown in FIG. 9 , the bone fusiondevice 900 comprises a body 902 housing one or more drive screws 904,904′ and one or more gears 906. At least one of the drive screws 904′ isable to be angled with respect to the elongated dimension of the body902 while still operable coupled with one of the gears 906.Alternatively, a plurality or all of the drive screws 904, 904′ are ableto be angled or non-parallel with respect to the elongated dimension ofthe body 902. As a result, a user is able to control the extension,retraction and angle adjustment of the tab (not shown) by rotating thegears 906 using the drive screws 904, 904′. In some embodiments, theangled drive screws 904′ are positioned such that the drive screw 904 issubstantially perpendicular to the elongated dimension of the body 902.Alternatively, the angled drive screws 904′ are able to be positionedsuch that they each form any angle with the elongated dimension of thebody 902 while still operably coupled to one of the gears 906. Thus, thebone fusion device 900 provides the advantage of allowing the tab to beextended/retracted and/or the angle of the tab adjusted from anglesother than parallel to the elongated dimension of the body, which iscritical in procedures where the device 900 is to be inserted fromvarying angles such as, for example, anterior lumbar interbody fusion,lateral lumbar interbody fusion or transforaminal lumbar interbodyfusion. Additionally, the differences to the bone fusion device 900described in FIG. 9 are able to be incorporated with and/or replacecomponents of each of the other bone fusion devices described herein.

A method of using the bone fusion device 800 according to someembodiments is illustrated by the flow chart in FIG. 10 . A user selectsthe body angle and/or top profile shape of a bone fusion device 800based on a type of lumbar interbody fusion to be performed at the step1002. In some embodiments, the user selects an elongated oval shape body814 based on the type being extreme lateral lumbar interbody fusion.Alternatively, the user selects a kidney or rounded shape body 814 basedon the type being anterior lumber interbody fusion. In some embodiments,the user selects the shape of the top profile of the body 814 of a bonefusion device 800 based on a horizontal profile of the bone or bones tobe fused to the device. For example, a bone fusion device is able to beselected because the device 800 has a top profile shape thatsubstantially matches the shape of the horizontal profile of a cervicalspinal bone or bones to be fused with. The user inserts the selectedbone fusion device 800 in between the desired bones according to thetype of lumbar interbody fusion to be performed at the step 1004. Insome embodiments, the bone fusion device 600 is able to be positionedoffset from the center of the adjacent bones and/or discs. Thus, themethod of using the bone fusion device 600 provides the advantage ofenabling a user to select a device 800 with desired dimensions of angleand/or top profile based on the type of procedure thereby increasing theeffectiveness of the procedure. Additionally, it should be noted thatone or more of the steps of the above method are able to be omitted orcombined with the other methods described herein.

A method of using the bone fusion device 900 according to someembodiments is illustrated by the flow chart in FIG. 11 . A user selectsa bone fusion device 900 having one or more drive screws 904, 904′ at adesired angle relative to the elongated dimension of the body 902 of thedevice 900 based on a type of lumbar interbody fusion to be performed atthe step 1102. In some embodiments, the user selects angled drive screws904′ that are substantially parallel to the elongated dimension of thebody 902 based on the type being anterior lumbar interbody fusion. Insome embodiments, the user selects a bone fusion device 900 havingangled drive screws 904′ at a desired angle relative to the elongateddimension of the body 902 based on the shape of the top profile of thebody 902 of a bone fusion device 900 and the type of lumbar interbodyfusion to be performed. The user inserts the selected bone fusion device900 in between the desired bones according to the type of lumbarinterbody fusion to be performed at the step 1104. Thus, the method ofusing the bone fusion device 900 provides the advantage of enabling auser to select a bone fusion device 900 having angled drive screws 904′that form a desired angle with the elongated dimension of the body 902of the bone fusion device 900 based on the type of procedure therebyincreasing the effectiveness of the procedure. In some embodiments, oneor more of the steps of the above method are able to be omitted orcombined with the other methods described herein.

FIG. 12 illustrates a perspective view of a distraction instrument 1200for measuring the space to be filled by a bone fusion device accordingto some embodiments. As shown in FIG. 12 , the distraction instrument1200 comprises a distraction body 1202 and a distraction head 1202operably coupled together. FIG. 13 illustrates a top cross sectionalview of the distraction body 1202 according to some embodiments. Asshown in FIG. 13 , the distraction body 1202 comprises a handle 1302, aengaging element 1304 and a guide element 1306. The handle 1302 iscoupled with the engaging element 1304 which is positioned within theguide element 1306 such that a user is able to rotate, push and/or pullthe handle 1302 in order to rotate, extend and/or retract the engagingelement 1304 within or further out of the guide element 1306. In someembodiments, the handle 1302 and/or guide element 1306 comprise one ormore gripping ridges enabling a user to rotate or otherwise move thehandle 1302 with respect to the guide element 1306 without slipping. Insome embodiments, the instrument 1200 is able to comprise an electricmotor and control interface (not shown) such that the movement of thehandle 1302 is able to be effectuated by a user controlling theoperation of the electric motor via the control interface. In someembodiments, the guide element 1306 comprises one or more a stop pins1310 that couple to the stop apertures 1417 of the rear fitting 1414 ofthe rear jack assembly 1404 (see FIG. 14 ). When coupled within the stopapertures 1417, the stop pins 1310 are able to prevent the distractionhead 1202 from rotating with the engaging element 1304 as well askeeping the rear fitting 1414 of the rear jack assembly 1404 abut theend of the guide element 1306. In some embodiments, the engaging element1304 comprises a threaded portion 1312 positioned along the end of theengaging element 1304 such that the threaded portion 1312 is able tooperably coupling with the threads 1418 of the front fitting 1415 of thefront jack assembly 1406 (see FIG. 14 ). As a result, when the engagingelement 1304 is rotated, the threaded portion 1312 is able to engage thethreads 1418 of the front fitting 1415 causing the front fitting 1415 toslide toward or away from the rear fitting 1414. Alternatively, thethreaded portion 1312 and the threads 1418 are able to be omitted andthe end of the engaging element 1304 is able to be coupled to the frontfitting 1415 such that when the engaging element 1304 is pulled into orpushed out of the guide element 1306 the coupling causes the frontfitting 1415 to also slide toward or away from the rear fitting 1414.Alternatively, the threaded portion 1312 is a female thread such thatwhen the engaging element 1304 is rotated, the threading 1312 causes theengaging element 1304 to retract into the guide element 1306 and thefront fitting 1415 to slide toward the rear fitting 1414. As a result,the engaging element 1304 does not protrude out of the front fitting1415 during the expanding or contracting of the plates 1402. In suchembodiments, the threading 1312, male or female is able to be positionedin other places along the engaging element 1304 and complimentingthreading is able to be positioned, for example, within the conduit 1416of the rear fitting 1414 or within the end of the guide element 1306.

In some embodiments, one or more of the handle 1302, engaging element1304 and/or the guide element 1306 comprise one or more indicators 1308that indicate values corresponding to the current separation between theplates 1402 of the head 1204 (see FIG. 14 ). In some embodiments, theindicators 1308 comprise first markings on the visually exposed surfaceof the engaging element 1304 and/or handle 1302 that move relative tocorresponding second markings on the guide element 1302 when theengaging element 1304 is rotated or otherwise moved. As a result, basedon the alignment of the first and second markings the current separationbetween the plates 1402 of the head 1204 is able to be determined.Alternatively, the indicators 1308 are able to comprise a digital oranalog readout/display that indicates the current level of distractionof the instrument 1200. In some embodiments, the motion of the handle1302 is effectuated by an electrical motor and the indicators 1308 areable to include the control interface for controlling the operation ofthe electrical motor. Alternatively, other types of indicating elements1308 corresponding to the current separation of the plates 1402 are ableto be used as are well known in the art.

In some embodiments, the indicators 1308 indicate a number ofrevolutions or rotations that the positioning element of a bone fusiondevice will require in order to extend the tabs to the height indicatedby the separation of the plates 1402. For example, in some embodimentsthe a user is able to input or the instrument 1200 is able to bepre-programmed with the type of bone fusion device to be used and basedon this data, the indicators 1308 are able to indicate the number ofrotations/revolutions that the positioning element of a bone fusiondevice will require in order to extend the tabs to the height indicatedby the separation of the plates 1402. In some embodiments, based on thedetermined current separation of the plates 1402, the indicators 1308are able to indicate a recommended size and/or type of bone fusiondevice to be used for filling the measured space. As a result, thedistraction instrument 1200 provides the advantage of indicating thebest type/size of bone fusion device to use and/or the exact amount ofrotation needed to a user of a bone fusion device such that the userdoes not overextend the tabs of the bone fusion device.

In some embodiments, the instrument 1200 comprises a force measurementcomponent (not shown) and/or the indicators 1308 indicate the amount offorce on the plates 1402 that is resisting the expansion/distraction ofthe plates 1402. In such embodiments, the distraction instrument 1200 isable to be configured to prevent the user from furtherextending/distracting the plates 1402 when a predefined and/oradjustable force threshold value is detected by the force measurementcomponent. For example, if the distraction is effectuated by anelectronically controlled motor the distraction system is able to beconfigured to automatically stop when the force threshold value isdetected. Alternatively, the force measurement component is able to beimplemented mechanically such that the components of the instrument 1200that effectuate the distraction of the plates 1402 prevent furtherdistraction when a predetermined and/or adjustable amount of resistanceis present. As a result, the distraction instrument 1200 provides thebenefit of enabling a user to manually stop, automatically stoppingand/or preventing the user for continuing to distract the plates 1402when the force measurement component and/or indicators 1308 indicatethat a predetermined amount of expansion resistant force is detected onthe plates 1402. Thus, the distraction instrument 1200 prevents overdistraction that which results in inaccurate measurements and possibleinjury.

FIG. 14 illustrates a perspective view of the components of theretraction head 1204 of the retraction instrument 1200 according to someembodiments. As shown in FIG. 14 , the retraction head 1204 comprises apair of retraction plates 1402 coupled together by a rear jack assembly1404 and a front jack assembly 1406. The rear and front jack assemblies1404, 1405 each comprise a rear/front fitting 1414, 1415 having afitting conduit 1416 and coupled to a plurality of legs 1422 via one ormore fitting pins 1420. Specifically, the plurality of legs 1422 eachhave a leg pin 1424 and a leg aperture 1419, wherein the leg apertures1419 are configured to slide onto a pair of fitting protrusions 1421such that the legs 1422 are able to pivot/rotate about the fittingprotrusions 1421 and are prevented from sliding off the protrusions 1421by the fitting pins 1420. As shown in FIG. 14 , two fitting protrusionsare each rotatably coupled to a pair of legs 1422. Alternatively, moreof less fitting protrusions 1421 are able to be rotatably coupled tomore or less legs 1422. Alternatively, the protrusions 1421 and/orfitting pins 1420 are able to be omitted and the legs 1422 are able tobe rotatably coupled to the fittings 1414, 1415 via other couplingmechanisms as are well known in the art.

In some embodiments, the conduit 1416 of the rear fitting 1414 is barewhereas the conduit 1416 of the front fitting 1415 has an innerthreading 1418 that is operably coupled to the threaded portion 1312 ofthe engaging element 1304 when the engaging element 1304 is positionedwithin the conduits 1416 of the retraction head 1204. As a result, theengaging element 1304 is able to freely move independent of the rearfitting 1414, but causes the front fitting 1415 to move toward or awayfrom the rear fitting 1414 along the engaging element 1304 when rotated.Alternatively, the threading 1418 of the conduit 1416 of the frontfitting 1415 is able to be omitted and the engaging element 1304 is ableto be otherwise coupled to the front fitting 1415 such that when theengaging element 1304 is pulled into or pushed out of the guide element1306 the coupling causes the front fitting 1415 to correspondingly slidetoward or away from the rear fitting 1414. In some embodiments, the rearfitting 1414 comprises one or more stop apertures 1417 that couple withthe stop pins 1310 in order to prevent the distraction head 1202 fromrotating with the engaging element 1304 and to keep the rear fitting1414 of the rear jack assembly 1404 in contact with the end of the guideelement 1306. Alternatively, the stop pins 1310 and stop apertures 1417are able to be omitted and the rear fitting 1414 is able to be coupledto the guide element 1306 via other coupling mechanisms as are wellknown in the art.

The retraction plates 1402 each comprise one or more leg pin apertures1408, a pair of fitting cavities 1410 and a plate channel 1412. The legpin apertures 1408 are configured to rotationally couple to the leg pins1424 such that the plates 1402 are coupled together via the front andrear jack assemblies 1404, 1406. Specifically, when the legs 1422 arecaused to rotate about the protrusions 1421 (due to movement of theengaging element 1304), the legs 1422 also rotate within the leg pinapertures 1408 about the leg pins 1424 causing the plates 1402 toselectively move apart or come together. When the plates 1402 arepositioned together the fitting cavities 1410 and plate channels 1412 ofthe upper plate 1402 align with the fitting cavities 1410 and platechannel 1412 of the lower plate 1402. As a result, the height of theretraction head 1204 in the retracted position is minimized because therear and front fittings 1414, 1415 are able to fit within the alignedfitting cavities 1410 and the engaging element 1412 is able to fitwithin the aligned plate channels 1412. This provides the advantage ofminimizing the size of the required surgical incision for the bonefusion surgery measurement operation.

FIGS. 15A and 15B illustrate cross sectional view of the head 1204 ofthe retraction instrument 1200 with the plates 1402 fully retracted andfully extended, respectively, according to some embodiments. As shown inFIG. 15A, when the retraction instrument 1200 is in the retractedposition, the plates 1402 are in contact such that the fittings 1414,1415 are all or partially housed within/between the plates 1402. Whilein this position, the retraction instrument 1200 creates the smallestprofile possible and thus is able to be surgically inserted between twovertebrae of a patient with a minimally invasive procedure. As shown inFIG. 15B, once in position, the user is able to rotate or otherwise movethe engaging element 1304 within the guide element 1306 and head 1204 bymanipulating the handle 1302. This manipulation causes the front fitting1415 to selectively move closer to the rear fitting 1414 andcorrespondingly the plates 1402 to move away from each other until thedesired measurement has been made or the maximum height has been reacheddue to the front fitting 1415 contacting the rear fitting 1414 along theengaging element 1304. The, user is then able to retract the plates 1402back together for removal using the opposite rotation and/or oppositeother movement of the engaging element 1304 via the handle 1302.Accordingly, the retraction instrument 1200 provides the advantage of aminimized retracted profile that enables a surgeon to measure the sizeof the space needed to be filled by a bone fusion device or other devicewhile minimizing the surgical incision required to take the measurement.

FIG. 16 illustrates a flow chart of a method of operating the retractioninstrument 1200 according to some embodiments. A user rotates orotherwise moves the engaging element 1304 until the head 1204 is in afully retracted position at the step 1602. The user inserts theretraction instrument 1200 into the desired position within the patientat the step 1604. In some embodiments, the desired position comprisesbetween or adjacent to one or more vertebrae. In some embodiments, theretraction instrument 1200 is inserted anteriorly. Alternatively, theretraction instrument 1200 is able to be inserted posteriorly, lateral,far-lateral or transforaminaly. The user rotates or otherwise moves theengaging element 1304 until the head 1204 is extended to a desiredheight at the step 1606. In some embodiments, the desired heightcomprises the height required such that the lower and upper plates 1402abut the vertebrae. The indicators 1308 indicate the amount ofseparation between the plates 1402 at the step 1608. In someembodiments, the indicators 1308 indicate a type and/or size of bonefusion device to utilize to fill the measured space. In someembodiments, the indicators 1308 indicate a number ofrotations/revolutions that the positioning element of a bone fusiondevice will require in order to extend the tabs to the height indicatedby the amount of separation of the plates 1402. In some embodiments, theindicators 1308 indicate the current amount of expansion resisting forceon the plates 1402. In some embodiments, the desired height comprisesthe height or separation of the lower and upper plates 1402 when theindicators 1308 indicate the plates 1402 are experiencing apredetermined expansion resisting force threshold value. The userretracts and removes the retraction device 1200 from the patient at thestep 1610. In some embodiments, the user then inserts the a bone fusiondevice into the desired position and extends the tabs such that the bonefusion device fills the indicated height. In some embodiments, the userextends the tabs such that the bone fusion device fills the indicatedheight by rotating the positioning element of the bone fusion device anumber of times indicated by the indicators 1308. In some embodiments,the bone fusion device inserted was selected based on size and/or typeof bone fusion device indicated by the indicators 1308. Therefore, theretraction instrument 1200 provides the advantage of determining thesize of the space within the patient while only requiring a smallincision and minimally invasive (arthroscopic) surgical procedure whichadvantageously promotes health and rapid recovery by the patient.Further, by determining the size of the space to be filled, theinstrument 1200 provides the advantage of enabling the user to select abone fusion device of the appropriate size to fit within the space andenables the user to pre-configure the tabs of the bone fusion device tonear the height required to fill the space such that minimal extensionof the tabs is required when the device is in place within the patient.

FIGS. 17A and 17B illustrate a top and cross-sectional side view of thebone fusion device 100 comprising a webbing 1700 according to someembodiments. As shown in FIGS. 17A and 17B, the webbing 1700 comprises awebbing body 1702 having at least one webbing aperture 1704 for eachjack 110A, 110B and one or more bracing members 1706. Specifically, thewebbing apertures 1704 are sized such that the jacks 110A, 110B fitsnugly within the webbing apertures 1704 and the bracing members 1706are sized such that they are able to brace the webbing 1700 against theinner walls of the body 102 when the jacks 110A, 110B are within thewebbing apertures 1704. As a result, the webbing 1700 is able to supportthe jacks 110A, 110B such that the jacks 110A, 110B are restricted frommoving along the plane of the webbing 1700 (e.g. laterally). In someembodiments, as shown in FIG. 17B, the webbing 1700 is able to bepositioned substantially parallel or orthogonal to the bottom of thedevice body 102. Alternatively, the webbing 1700 is able to bepositioned at an angle 1708 in any direction with respect to the planeformed by the bottom of the device body 102. In some embodiments, thewebbing body 1702 is substantially planar. Alternatively, the webbingbody 1702 is able to have bends and/or curves in order to better fitwithin the body 102 and/or support the jacks 110A, 110B. Alternatively,the webbing body 1702 is able to extend to the bottom of the innersurface of the body 102 such that the webbing body 1702 is seated on thebottom of the inner surface of the body 102. In such embodiments, theupper surface of the webbing body 1702 is able to be substantiallyplanar or have bends and/or curves in order to better fit within thebody 102 and/or support the jacks 110A, 110B. In some embodiments, thebone fusion device 100 is able to comprise a plurality of webbing bodies1700 positioned at the same or different angles in order to provideincreased support to the jacks 110A, 110B. In some embodiments, thewebbing body 1702 comprises elastic materials such that as the jacks110A, 110B move and apply force to the webbing body 1702, the webbingbody 1702 resists the movement along the plane of the webbing 1700 asthe movement increases and springs the jacks 110A, 110B back in place asthe force subsides. Alternatively, the webbing body 1702 is able tocomprise inelastic or rigid materials such that the jacks 110A, 110B aresubstantially prevented from moving along the plane of the webbing 1700.Alternatively, the webbing body 1702 is able to comprise both elasticand inelastic material such that the elastic portions allow somemovement of the jacks 110A, 110B, but the inelastic portions limit theextent of this movement. Although the webbing 1700 is shown in FIG. 17Aas comprising six bracing members 1706, it is understood that any numberof bracing members 1706 are able to be used and each is able to be ofvarying sizes and positioned along any portion of the perimeter of thewebbing 1700. For example, the webbing body 1702 is able to comprise asingle bracing member 1706 that forms the entire perimeter of thewebbing 1700 and abuts the inner perimeter of the device body 102. Also,although the webbing 1700 is described in reference to the bone fusiondevice 100, it is understood that the webbing 1700 is able to be used inconjunction with the other bone fusion devices described herein.

FIGS. 18A and 18B illustrate perspective views of a bone fusion system2100 according to some embodiments. The bone fusion devices 2102 shownin FIGS. 18A and 18B are substantially similar to the bone fusion device100 except for the differences described herein. The bone fusion system2100 comprises one or more bone fusion devices 2102 and one or more bonegrafting material bags 2104. As shown in FIG. 18A, the bone graftingmaterial bags 2104 are able to be positioned and/or coupled within thebone fusion device 2102. Additionally, as shown in FIG. 18B, thematerial bags 2104 are also able to be positioned or coupled outside ofthe bone fusion device 2102. FIG. 19 illustrates a perspective view of abone grafting material bag 2104 according to some embodiments. As shownin FIG. 19 , the material bag 2104 comprises a mesh frame 2202, one ormore support bars 2204, at least one opening 2206 for filling the bag2104 with bone graft material, one or more bag fasteners 2208 and one ormore bag coupling elements 2210. In some embodiments, the support bars2204, bag fasteners 2208 and/or bag coupling elements 2210 are able tobe omitted. The support bars 2204 couple to the mesh frame 2202 in orderto help the mesh frame 2202 maintain its shape. In some embodiments, theshape of the mesh frame 2202 is a cylinder (as shown in FIGS. 18A and 19). Alternatively, the shape of the mesh frame 2202 is able to be a“half-moon” prism (as shown in FIG. 18B) or other shapes capable ofholding a volume of bone grafting material as are well known in the art.In some embodiments, the support bars 2204 comprise polymeric materialssuch that the support bars 2204 are able to maintain the shape of thematerial bag 2104. Alternatively, the support bars 2204 are able tocomprise other materials capable of supporting the shape of the bag 2104as are well known in the art.

The opening 2206 enables bone grating material to be packed into thebone grafting material bag 2104 and is able to vary in size based on thesize of the mesh frame 2202. The bag fastener 2208 is positioned on themesh frame 2202 such that the bag fastener 2208 is able to releasablyclose or fasten the opening 2206 shut such that bone grafting materialwithin the material bag 2104 is unable to escape through the opening2206. In some embodiments, the bag fastener 2208 comprises a hoop aroundthe opening 2206 and a cinch cord to selectively cinch closed theopening 2206. Alternatively, the bag fasteners 2208 are able to compriseother types of fastening means as are well known in the art. In someembodiments, the material bags 2104 are able to comprise a plurality ofopenings 2206 and at least one bag fastener 2208 for each opening. Thebag coupling element 2210 enables the material bag 2104 to be coupled toone or more bone fusion devices 2102 and/or other material bags 2104. Asa result, the bone fusion system 2100 provides the advantage of enablingthe user to physically pack a material bag 2104 full of bone graftingmaterial in order to maximize the amount of grafting material providedto the bones. Further, the system 2100 provides the advantage of keepingthe bone grafting material in the desired location and shape withrespect to the bones to be fused to and/or the position of the bonefusion device 2102 thereby increasing the efficiency of the bone growthand/or healing process. Additionally, it should be noted that one ormore of the components of the bone fusion system 2100 are able to beincorporated into the bone fusion system 1000 described above inreference to FIGS. 10-12 and vice versa.

A method of using the bone fusion system 2100 according to someembodiments is illustrated by the flow chart in FIG. 20 . A user selectsone or more bone grafting material bags 2104 based on the shape and sizeof the material bags 2104 at the step 2302. The user fills one or moreof the selected bone grafting material bags 2104 with bone graftingmaterial at the step 2304. In some embodiments, the material bag 2104 isfilled with the bone grafting material with an implement resembling a“caulking gun.” Alternatively, the material bag 2104 is able to befilled by a packing element and/or other methods of packing bonegrafting material as are well known in the art. The user couples the oneor more material bags 2104 within and/or outside the bone fusion device2102 at the step 2306. The user moves the bone fusion system 2100 intothe desired position within the patient at the step 2308. In someembodiments, the material bags 2104 are positioned such that they abutthe bones adjacent the bone and/or disc to be replaced. Thus, the methodof using the bone fusion system 2100 provides the advantage of allowingthe bone grafting material to be packed into the material bags andkeeping the bone grafting material in the desired position and/or shapewith respect to the adjacent bones and bone fusion device 2102 such thatquicker and stronger bone fusion is promoted speeding up the healingprocess. Additionally, it should be noted that one or more of the stepsof the above method are able to be omitted or combined with the othermethods described herein.

FIG. 22 illustrates a bone fusion device 2500 having a position lockingmechanism 2502 according to some embodiments. The bone fusion device2500 shown in FIG. 25 is substantially similar to the bone fusion device100 except for the differences described herein. It is noted that thetab 104 of the bone fusion device 2500 have been omitted from FIG. 22for the sake of clarity. As shown in FIG. 22 , the body 102 comprisesone or more locking apertures 2502 configured to receive one or moreposition locking mechanisms 2503, wherein each of the position lockingmechanisms 2503 comprise one or more dials 2504 and one or more stoppers2506. In some embodiments, the device 2500 comprises a locking aperture2502 and a position locking mechanism 2503 for each tab extensionassembly or drive screw 106A, 106B. Alternatively, one or more of thetab extension assemblies or drive screws 106A, 106B are able to havemore or less than one locking aperture 2502 and/or position lockingmechanism 2503.

The dial 2504 is configured to rotatably fit within the lockingapertures 2502 and comprises a dial aperture 2512 and one or moredimples 2510 along the edge or perimeter of the dial 2504. The dialaperture 2512 is able to be sized or otherwise configured to receive anend of one of the drive screws 106A, 106B such that if a drive screw106A, 106B is within the dial aperture 2512, the end of the drive screw106A, 106B will cause the dial 2504 to rotate along with the drive screw106A, 106B. In some embodiments, the drive screw 106A, 106B causes thedial 2504 to rotate by directly physically contacting the dial aperture2512. Alternatively, the drive screw 106A, 106B is able to cause thedial 2504 to rotate via indirect contact. The one or more dimples 2510are able to be configured to receive one or more bumps 2508 of thestoppers 2506. In particular, the dimples 2510 are able to have concavedimensions that substantially match convex dimensions of the bumps 2508.The stoppers 2506 are able to be configured to fit within the lockingapertures 2502 adjacent to the dial 2504 and comprise one or more bumps2508. The stoppers 2506, dials 2504 and apertures 2502 are configuredsuch that when within the locking apertures 2502, the stoppers 2506 areadjacent or in contact with the dial 2504 and the bumps 2508 of thestoppers 2506 snap or spring fit within the dimples 2510 of the dial2504 when a dimple 2510 and a bump 2508 are aligned. Additionally, whena dimple 2510 and a bump 2508 are not aligned, the bump 2508 iscompressed against the dimple-less edge of the dial 2504 and primed tospring or decompress into a dimple 2510 when alignment is achieved.

In some embodiments, the dial 2504 is held in place within the lockingapertures 2502 by force applied by the bumps 2508 of the stoppers 2506.Alternatively, the dial 2504 is able to be otherwise coupled oruncoupled within the locking apertures 2502 by one or more fasteningelements as are well known in the art. In some embodiments, the stoppers2506 are held in place within the locking apertures 2502 by placeholders 2507. In particular, the place holders 2507 are able to betensioned and/or compressed by the wall of the locking apertures 2502when the stoppers 2506 are inserted into the locking apertures 2502 andthus provide a spring force against the walls of the locking apertures2502 to try and relieve that tensioning/compression. Accordingly, thespring force holds the stoppers 2506 within the locking apertures 2502.Alternatively, one or more of the stoppers 2506 are able to be otherwisecoupled or uncoupled within the locking apertures 2502 by one or morefastening elements as are well known in the art. Although as shown inFIG. 22 , the device 2500 comprises one side of the body 102 includingtwo position locking mechanisms 2503, wherein the position lockingmechanisms 2503 comprise a single dial 2504 having sixteen dimples 2510and two stoppers 2506, it is understood that any of the sides of thebody 102 are able to include one or more position locking mechanisms2503 and the position locking mechanisms 2503 are able to include anynumber of dials 2504 having any number of dimples 2510 coupled to anynumber of stoppers 2506.

In operation, as the drive screws 106A, 106B are rotated to extend orretract sides of the tab 104, the dial 2504 is rotated along with thedrive screws 106A, 106B and the bumps 2508 compress and decompress intoand out of the dimples 2510 as they move in an out of alignment with thebumps 2508. As a result, each point during the rotation of the drivescrews 106A, 106B that results in an alignment of a bump 2508 and adimple 2510 serves as a demarcated degree of rotation and/or degree ofextension/retraction of the associated side of the tab 104. In this way,the position locking mechanism 2503 provides the advantage of enabling auser to rotate the drive screws 106A, 106B and thereby extend the sidesof the tab 104 to predetermined rotation/extension amounts and/or bypredetermined rotation/extension intervals represented by the spacingand number of dimple 2510 and bump 2508 alignment points. For example,the position and/or number of dimples 2510 and/or bumps 2508 of theposition locking mechanism 2503 is able to be adjusted to adjust thenumber and/or position of the alignment points and therefore the numberand/or position of plate extension points. Thus, the position lockingmechanism 2503 of the bodiless bone fusion device 2500 is able to betuned to different size devices 2500 based on the number of extensionincrements needed and the desired extension distance interval betweeneach of the increments. In some embodiments, the increments areconfigured to be constant. Alternatively, the increments are able to beconfigured to decrease in size as the sides of the tab 104 approachtheir maximum extension level. Alternatively, other increment profilesare able to be used as are well known in the art. Further, thecompression of the bumps 2508 and their resistance thereto duringrotation of the drive screws 106A, 106B between alignment pointsprovides a slipping resistance force the resists unintended rotation ofthe drive screws 106A, 106B out of an alignment point. As a result, theposition locking mechanism 2503 provides the advantage of reducing thechance of the drive screws 106A, 106B unintentionally rotating and/orthe sides of the tab 104 unintentionally extending or retracting.

Thus, the bone fusion device, system and method described herein hasnumerous advantages. First, the bone fusion device, system and methodprovide the advantage of substantially matching the device or tab topsurface profiles with the horizontal profiles of the bones to be fused,thereby increasing the strength and efficiency of the fusion process. Asa result, the bone fusion device does not need to be turned to be in theproper orientation between the bones of the patient whether theprocedure is anterior, posterior, lateral or transforaminal lumbarinterbody fusion. Second, the bone fusion device, system and methodprovide the advantage of allowing the body to be extended from anglesother than parallel to one or more of the drive screws, which iscritical in procedures where the device is to be inserted from varyingangles. Third, the extension measurement instrument provides theadvantage of enabling a user to accurately measure the size of the spaceto be filled by the bone fusion device thereby allowing the correct bonefusion device to be selected, while also having a minimal profile suchthat the incision required is minimized. Further, the bone fusiondevice, system and method provides the advantage of enabling each sideof the tab to be individually adjusted such that the side controlled byeach assembly is raised or lowered until the desired tab angle isachieved. In this way, the tab is advantageously positioned and angledto correspond to the vertebrae to help brace the device until the bonehas fused and to provide a larger surface area to which the bones attachand fuse during a healing period. Moreover, the bone fusion device,system and method provides the advantage of enabling the user tophysically pack a material bag full of bone grafting material in orderto maximize the amount of grafting material provided to the bones, aswell as providing the advantage of keeping the bone grafting material inthe desired location and shape with respect to the bones to be fused toand/or the position of the bone fusion device thereby increasing theefficiency of the bone growth and/or healing process. Additionally, theposition locking mechanism provides the advantage of reducing the chanceof the drive screws unintentionally rotating and/or the sides of the tabunintentionally extending or retracting. Finally, the bone fusiondevice, system and method provides the advantage of allowing the bonegrafting material to be packed into the material bags and keeping thebone grafting material in the desired position and/or shape with respectto the adjacent bones.

The present invention has been described in terms of specificembodiments incorporating details to facilitate the understanding ofprinciples of construction and operation of the invention. Suchreference herein to specific embodiments and details thereof is notintended to limit the scope of the claims appended hereto. It will beapparent to those skilled in the art that modification may be made inthe embodiments chosen for illustration without departing from thespirit and scope of the invention.

1. A bone fusion device for insertion into a desired locationcomprising: a body; a tab configured to selectively move from aretracted position to an extended position at least partially protrudingfrom the body; a first extension assembly comprising a first drivemechanism and a first drive screw having a first cutout, the firstextension assembly configured to selectively move the tab between therefracted position and the extended position; and a second extensionassembly comprising a second drive mechanism and a second drive screw,the second extension assembly configured to selectively move the tabbetween the refracted position and the extended position, wherein aportion of the second drive mechanism is positioned within the firstcutout of the first drive screw.
 2. The device of claim 1, wherein eachof the first and second drive mechanisms comprise a worm gear operablycoupled between the first or second drive screw and a support jack suchthat rotation of the first or second drive screw rotates the worm gearwhich refracts or extends the support jack into or out of the worm gear.3. The device of claim 2, wherein at least one of the first and seconddrive screws is accessible through a first lateral side of the body andat least another one of the first and second drive screws is accessiblethrough a second lateral side of the body.
 4. The device of claim 1,wherein the first and second extension assemblies are pivotably coupledto different portions of the tab such that the tab is able to pivotabout the first and second extension.
 5. The device of claim 1, whereinthe body has a bottom surface and an upper surface, wherein the uppersurface is angled with respect to the bottom surface.
 6. The device ofclaim 1, further comprising one or more plugs, wherein the body and thetab comprise one or more holes that extend from outside the device to aninner cavity of the body and are configured to be removably filled bythe plugs.
 7. The device of claim 6, wherein the plugs comprise bonematerial.
 8. The device of claim 1, wherein the tab comprises one ormore tangs positioned along a perimeter of a top surface of the tab andfit within recesses in a top surface of the body when the tab is in theretracted position.
 9. The device of claim 8, wherein one or more of thetangs extend from a perimeter of the tab to a perimeter of the body. 10.The device of claim 2, further comprising a support webbing positionedwithin an inner cavity of the body between one or more walls of theinner cavity and the exterior of the worm gears such that the supportwebbing resists lateral movement of the worm gears with respect to thewalls of the inner cavity.
 11. A method of implanting a bone fusiondevice into a desired location, the method comprising: inserting thebone fusion device in the desired location, wherein the bone fusiondevice comprises a body, a tab configured to selectively move from aretracted position to an extended position at least partially protrudingfrom the body, a first extension assembly comprising a first drivemechanism and a first drive screw having a first cutout, the firstextension assembly configured to selectively move the tab between theretracted position and the extended position, and a second extensionassembly comprising a second drive mechanism and a second drive screw,the second extension assembly configured to selectively move the tabbetween the retracted position and the extended position, wherein aportion of the second drive mechanism is positioned within the firstcutout of the first drive screw; and extending the tab from theretracted position to a position at least partially outside the interiorcavity by moving at least one of the first drive screw and the seconddrive screw.
 12. The method of claim 11, further comprising adjusting anamount which a first portion of the tab coupled to the first drivemechanism is extended compared to an amount which a second portion ofthe tab coupled to the second drive mechanism is extended such that anangle of the tab with respect to the body is adjusted.
 13. The method ofclaim 11, wherein each of the first and second drive mechanisms comprisea worm gear operably coupled between the first or second a drive screwand a support jack such that rotation of the first or second drive screwrotates the worm gear which retracts or extends the support jack into orout of the worm gear.
 14. The method of claim 13, wherein at least oneof the first and second drive screws is accessible through a firstlateral side of the body and at least another one of the first andsecond drive screws is accessible through a second lateral side of thebody.
 15. The method of claim 11, wherein the first and second extensionassemblies are pivotably coupled to different portions of the tab suchthat the tab is able to pivot about the first and second extensionassemblies.
 16. The method of claim 11, wherein the body has a bottomsurface and an upper surface, wherein the upper surface is angled withrespect to the bottom surface.
 17. The method of claim 11, furthercomprising removably filling one or more holes with one or more plugs,wherein the body and the tab comprise the one or more holes, whichextend from outside the device to an inner cavity of the body and areconfigured to be removably filled by the plugs.
 18. The method of claim17, wherein the plugs comprise bone material.
 19. The method of claim11, wherein the tab comprises one or more tangs positioned along aperimeter of a top surface of the tab and fit within recesses in a topsurface of the body when the tab is in the retracted position.
 20. Themethod of claim 19, wherein one or more of the tangs extend from theperimeter of the tab to a perimeter of the body.
 21. The method of claim13, wherein the device further comprises a support webbing positionedwithin an inner cavity of the body between one or more walls of theinner cavity and the exterior of the worm gears such that the supportwebbing resists lateral movement of the worm gears with respect to thewalls of the inner cavity.
 22. The method of claim 11, furthercomprising retracting the tab of the bone fusion device into theretracted position before inserting the bone fusion device into thedesired location. 23-40. (canceled)
 41. A bone fusion device forinsertion into a desired location comprising: a body; a tab configuredto selectively move from a retracted position to an extended position atleast partially protruding from the body; a first extension assemblyconfigured to move the tab between the retracted position and theextended position, the first extension assembly comprising a first drivescrew to control extension of the first extension assembly; and a secondextension assembly configured to move the tab between the retractedposition and the extended position, the second extension assemblycomprising a second drive screw to control extension of the secondextension assembly, wherein the second drive screw is non-coaxial to thefirst drive screw.
 42. The device of claim 41, wherein each of the firstand second extension assemblies are configured to independently movedifferent portions of the tab between the retracted position and theextended position.
 43. The device of claim 42, further comprising aposition locking mechanism operably coupled with each of the first andsecond extension assemblies and configured to provide a plurality oflocking positions that the first and second extension assemblies arebiased to stay in by the position locking mechanism, wherein theposition locking mechanism comprises a dial operably coupled with one ofthe first and second extension assemblies such that when the one of thefirst and second extension assemblies is rotated the dial is alsorotated.
 44. The device of claim 43, wherein the position lockingmechanism comprises one or more stops operably coupled with the dialsuch that when the one of the first and second extension assemblies isin one of the locking positions the interface between the dial and thestops provides a biasing force that resists the movement of the one ofthe first and second extension assemblies out of the one of the lockingpositions.